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SingHealth breach review recommends remedies that should already be basic security policies - Former exec enters plea agreement in $4.6M kickback scheme - Therapist charged in state Medicaid fraud - And More

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SingHealth breach review recommends remedies that should already be basic security policies

Former exec enters plea agreement in $4.6M kickback scheme

Therapist charged in state Medicaid fraud

Former State Rep. Ed Henry to plead guilty in kickback scheme

Former Russell County psychiatrist sentenced to seven months for health care fraud

Is GDPR Compliance Tougher Than HIPAA Compliance?

NY AG: Nurses steal $750K from Brooklyn Hospital

Conviction of “Three-Quarter House” director charged with defrauding Medicaid through a kickback scheme

DOJ updates its Justice Manual to include section limiting use of guidance documents in litigation

 

No more mooncakes: New pharma code bans all Rx company gifts

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CMS Update

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In the Federal Register

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SingHealth breach review recommends remedies that should already be basic security policies

On January 10, 2019, ZDNet reported, “A culmination of bad system management and undertrained IT staff, amongst other gaps, had resulted in Singapore's most severe cybersecurity breach last July, according to the committee formed to review the events leading up to the SingHealth incident.”

 

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Former exec enters plea agreement in $4.6M kickback scheme

On January 9, 2019, Nashville Post reported, “Former Tennessee health care exec Brenda Montgomery, who last April was charged for her participation in a $4.6 million Medicare kickback scheme, has signed on to a plea agreement with the federal government.

“Montgomery, 70, pled guilty to eight of the 15 counts brought against her for a kickback scheme she orchestrated with former Brentwood-based Comprehensive Pain Specialists CEO John Davis.”

 

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Therapist charged in state Medicaid fraud

On January 9, 2019, Arkansas Democrat Gazette reported, “A former mental health therapist at Preferred Family Healthcare has been arrested and accused of billing Arkansas' Medicaid program for services she didn't provide, state Attorney General Leslie Rutledge said Tuesday.

 

“Kandice Robinson, 33, of Bartlett, Tenn., is the fourth employee or former employee of the Missouri-based health provider to be charged in state court with Medicaid fraud in the past year.”

 

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Former State Rep. Ed Henry to plead guilty in kickback scheme

On January 9, 2019, WSFA 12 News (AL) reported, “Court documents indicate Ed Henry will plead guilty to charges surrounding a kickback scheme aimed to defraud a federal health care program.

 

“The charges stem from Henry’s former business, MyPractice24, that provided chronic care management services for Medicare Part B recipients.”

 

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Former Russell County psychiatrist sentenced to seven months for health care fraud

On January 9, 2019, News 5 (VA) reported, “A former Russell County psychiatrist who admitted in October to bilking an insurance company and Medicaid of thousands of dollars received a 7-month prison [sentence] from a federal judge.”

 

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Is GDPR Compliance Tougher Than HIPAA Compliance?

On January 9, 2019, Bank Info Security reported, “An EU General Data Protection Regulation enforcement action against a hospital in Portugal demonstrates for U.S. healthcare entities that complying with GDPR may be even tougher than complying with HIPAA.”

 

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NY AG: Nurses steal $750K from Brooklyn Hospital

On January 8, 2019, Patch.com reported, “Two nurses stole $750,000 from a Crown Heights nonprofit hospital that recently declared bankruptcy, the Attorney General's office announced Tuesday.”

 

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Conviction of “Three-Quarter House” director charged with defrauding Medicaid through a kickback scheme

On January 8, 2019, New York Attorney General Letitia James announced, “the conviction of Robert H. Corrado, 57 and Interline Employee Assistance Program, Inc. (Interline) for engaging in a systematic kickback scheme and violating patients’ rights.”

 

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DOJ updates its Justice Manual to include section limiting use of guidance documents in litigation

On January 7, 2019, The National Law Review reported, “Nearly one year ago, on January 25, 2018, the Department of Justice’s (DOJ) Regulatory Reform Task Force issued a memorandum entitled ‘Limiting Use of Agency Guidance Documents In Affirmative Civil Enforcement Cases.’ Many refer to this memorandum as the ‘Brand Memo’ because it was authored by Associate Attorney General Rachel Brand.”

 

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No more mooncakes: New pharma code bans all Rx company gifts

On January 3, 2019, Bloomberg Law News reported, “t’s a whole new world for drugmakers operating abroad.

“Starting Jan. 1, companies can no longer give gifts or cash payments to business associates—traditions that are accepted and sometimes expected—in China and other parts of the world. The change is causing concern among both U.S.-based and multinational companies like Astra Zeneca, Bristol-Myers Squibb, Johnson & Johnson Inc., and Pfizer Inc. about how to balance appropriate business behavior with respect for cultural norms in other countries.”

 

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CMS Update

 

Provider Compliance - Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims — Reminder

A 2017 Office of the Inspector General (OIG) report noted that, in some cases, pharmacies incorrectly billed Medicare Part B for claims using the KX modifier for immunosuppressive drugs. It is estimated that Medicare paid $4.6 million for these claims that did not comply with Medicare requirements.

In response to this report, CMS clarified manual instructions on the use of the KX modifier to help pharmacies document the medical necessity of organ transplant and eligibility for Medicare coverage. Resources for pharmacies:

 

 

 

 

In the Federal Register

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CMS Transmittals

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Please feel free to contact Margaret Dragon, editor of Compliance Weekly News.

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Health Care Compliance Library
HCCA offers members and registered guests access to an extensive library of articles. Information provided covers topics in corporate compliance and ethics in healthcare organizations. Contributing authors include attorneys, chief compliance officers, providers of auditing, monitoring, coding, billing and technology services, and other members of our compliance community.